Sunday, January 15, 2006

gallbladder disease (cholelithiasis, gallbladder stones, gallstones, biliary Colic, cholecystectomy)

A gallstone is a concretion formed in the gallbladder. Gallstones are the most common abnormality of the biliary system. They occur in 20 percent of people over 40 years old. This increases progressively with age. Gallstones occur four times more often in women than men, especially with a history of pregnancy, diabetes, or obesity.
Acute cholecystitis is a common complication of gallstones. Symptoms are secondary to blockage of the outflow of bile due to stones or spasms of the ductal system. Symptoms usually flare up after a meal containing fried, greasy, spicy, or fatty foods. The patient may have belching, nausea, and discomfort in the right upper abdominal area. This discomfort ranges from cramps to very severe pain. Very severe pain is called biliary colic. This pain may radiate to the back and shoulder. Vomiting may occur with biliary colic (intense pain felt in the right upper quadrant of abdomen from impaction of a gallstone in the gallbladder or liver. In addition to the subjective symptoms the diagnosis is confirmed by a cholecystogram (gallbladder series). The evening before the test, special dye-containing tablets are given to the patient and foods and liquids are withheld. After ingestion the dye reaches the liver and is excreted into the bile and passes into the gallbladder, making it radiographically visible.
Usually removal of the gallbladder (cholecystectomy) is advised. Surgeons prefer to operate electively rather than in an emergency situation as complications are reduced. People who are admitted with an attack of biliary colic are treated with rest, bland liquid diet, and sedation. If vomiting occurs nasogastric suction and parenteral fluids may be needed. Meperidine or other narcotic analgesics may be used to relieve severe pain. These drugs can cause spasm of the common bile duct and the sphincter of Oddi and should be used sparingly.
People whose attacks continue to worsen are usually treated surgically. Cholecystectomy is performed under general anesthesia.
Scherer, J. C. Introductory Medical-Surgical Nursing, 3rd ed. Philadelphia: J. B. Lippincott Co., 1982.
Steinberg, F. U. Care of the Geriatric Patient. 6th ed. St. Louis: C.V. Mosby Co., 1983.

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